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Copyright of Ultrasound in Obstetrics & Gynecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Major depressive disorder (MDD) can have severe impacts on function and quality of life. Up to one third of patients will have an inadequate response to their first line of treatment, with subsequent lines of therapy associated with lower remission rates and higher relapse rates. Recently esketamine has become available for Australian patients, and this agent provides an additional treatment option for those with MDD who have had an inadequate response to two or more antidepressant therapies during the current moderate to severe depressive episode. This paper provides an expert panel's practical recommendations and clinical guidance for establishing esketamine clinics in Australia. Methods: An expert panel (n = 11) comprising psychiatrists, mental health care nurses, pharmacists, and individuals with experience establishing esketamine clinics was convened in Sydney. The panel developed practical recommendations and clinical guidance, which were then further refined. Results: Five key areas were identified: practical considerations for esketamine clinic set‐up, including multidisciplinary care considerations; patient selection; administering esketamine; adverse event management and long‐term follow‐up. Conclusions: Guidance presented in this paper should assist Australian clinicians to set up an esketamine clinic, and provide practical advice on the infrastructure and clinical requirements for treatment of patients with this agent. [ABSTRACT FROM AUTHOR]

Compare the neonatal outcomes of two protocols of diagnosis and surveillance of pregnancies complicated by early-onset FGR in a tertiary hospital. This is a retrospective cohort study of pregnant women diagnosed with early-onset FGR between 2017 and 2020. We compared the obstetric and perinatal outcomes between two different management protocols (before and after 2019). Seventy-two cases of early-onset FGR were diagnosed in the forementioned period: 45 (62.5%) were managed according to protocol 1 and 27 (37.5%) according to protocol 2. Mean gestational age at delivery was significantly different between groups: 34.9 ± 3.1 weeks (95% CI 34.0–35.9) in group 1 and 32.3 ± 4.4 weeks (95% CI 30.4–33.9) in group 2. 74.1% (20) of newborns in group 2 were admitted in de NICU, a significant difference when compared with 46.7% of group 1. There were no statistically significant differences in the remaining serious neonatal adverse outcomes. This is the first study published comparing two different protocols of management of FGR. The implementation of the new protocol seems to have led to a decrease in the number of fetuses labeled as growth restricted and to a decrease in the gestational age of delivery of such fetuses, but without increasing the rate of serious neonatal adverse outcomes. The implementation of the 2016 ISUOG guidelines for the diagnosis of fetal growth restriction seems to have led to a decrease in the number of fetuses labeled as growth restricted and to a decrease in the gestational age of delivery of such fetuses, but without increasing the rate of serious neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Sirolimus constitutes a safe and effective treatment for cardiac manifestations of tuberous sclerosis complex (TSC) in children but only four cases describing prenatal treatment of rhabdomyomas with mTOR inhibitors have been published. In this case, sirolimus was initiated at 26 weeks´ gestation in a pregnant woman with TSC with a fetus with a large rabdomyoma conditioning severe arrhythmia. There was a significant reduction in the tumor size with ongoing treatment and a partial reversion of the arrhythmia. m-TOR inhibitors can be considered for severe cases of fetal rhabdomyomas with poor prognosis given its potencial benefits. [ABSTRACT FROM AUTHOR]

Background: Medial hamstring lengthening is frequently used to correct contractures in neuromuscular conditions such as cerebral palsy. Surgical techniques vary considerably and little is known about the lengthening characteristics of muscle-tendon-units after surgical intervention. Methods: A randomized trial was performed on paired cadaver medial hamstring muscle-tendon-units comparing 'High' (proximal) versus 'Low' (distal) lengthening procedures. The paired muscle-tendon-units were subjected to tensile testing utilizing an Instron® (Instron Corporation, Canton, MA, USA) machine under controlled conditions. Prior to tensile testing, the paired semitendinosus and paired gracilis received either high or low intramuscular tenotomy. Load (N) versus displacement (mm) was recorded continuously for each test. The difference in lengthening and load at failure for intact and surgical simulation muscle-tendon-units was recorded and compared with paired t-tests. Results: Both low and high lengthenings increased the amount of lengthening achieved compared with intact controls and the lengthening was achieved at lower applied load. Low intramuscular tenotomy of the semitendinosus resulted in a 30% greater lengthening when compared with high intramuscular tenotomy. For the gracilis muscle, the low intramuscular tenotomy achieved 39% greater lengthening than the high intramuscular tenotomy and these differences were significant. Conclusion: Biomechanical testing of formalin-preserved human cadaveric medial hamstring muscle-tendon-units confirms that it is possible to achieve lengthening in continuity following an intramuscular tenotomy or fascial striping procedure. The site of the surgical procedure (high versus low) results in a different effect on the lengthening characteristics, dictated by the anatomy of the particular muscle-tendon-unit. [ABSTRACT FROM AUTHOR]

Background: Lengthening of soft-tissue contractures is frequently required in children with a wide variety of congenital and acquired deformities. However, little is known about the biomechanics of surgical procedures which are commonly used in contracture surgery, or if variations in technique may have a bearing on surgical outcomes. We investigated the hypothesis that the site of intramuscular tenotomy (IMT) within the muscle-tendon-unit (MTU) of the tibialis posterior (TP) would affect the lengthening characteristics. Methods: We performed a randomized trial on paired cadaver tibialis posterior muscle-tendon-units (TP-MTUs). By random allocation, one of each pair of formalin-preserved TP-MTUs received a high IMT, and the other a low IMT. These were individually tensile-tested with an Instron machine under controlled conditions. A graph of load (Newtons) versus displacement (millimetres) was generated for each pair of tests. The differences in lengthening and load at failure for each pair of TP-MTUs were noted and compared using paired t tests. Results: We found 48% greater lengthening for low IMT compared to high IMT for a given load ( P = 0.004, two tailed t test). Load at failure was also significantly lower for the low IMT. These findings confirm our hypothesis that the site of the tenotomy affects the amount of lengthening achieved. This may contribute to the reported variability in clinical outcome. Conclusions: Understanding the relationship between tenotomy site and lengthening may allow surgeons to vary the site of the tenotomy in order to achieve pre-determined surgical goals. It may be possible to control the surgical 'dose' by altering the position of the intramuscular tenotomy within the muscle-tendon-unit. [ABSTRACT FROM AUTHOR]

This article is the first in a series which describes maternity services in Scotland. Although part of the UK, culturally and geographically Scotland is very different and this is reflected in the way health and maternity services are planned, organised and delivered. Scotland has a mainland area of 28,269 square miles (73,217 square kilometres); including inhabited islands, it has an overall area of 30,418 square mites with a population of five million. In contrast the total area of Wales Is 20,768 square kilometres (8019 square miles) with a population of 3 million and Northern Ireland is 5,240 square miles in size and has a population of 1.69 million. England meanwhile, is 93,000 square miles In size with a population of 58 million people. So, although Scotland is 25% the size of England it only has 8.5% of the population. Not surprisingly, remote and rural health and maternity care figure greatly on the Scottish Executive Health Department agenda and a Remote and Rural Resource initiative is in place to address specific remote and rural health care issues. [ABSTRACT FROM AUTHOR]

The cavum septi pellucidi (CSP) is an important landmark in evaluation of the fetal brain, because its visualisation provides reassurance of normal central forebrain development. CC length measurements were always inferior to the 5th centile and the head circumference reduced from 13th to 5th centile. Non-visualisation of the CSP during pregnancy may stem from agenesis of the septa, lack of formation or obliteration of the space between them. [Extracted from the article]

Investigates electromigration in thin films of aluminum and aluminum alloys. Consideration of the electrical 1/frequency noise as an early indication of electromigration damage; Factors attributed to failure of very-large-scale-integration electronic devices; Employment of a phase-sensitive alternating current correlation method.